Rural patients face ‘blackouts’ as pharmacies threaten to cut key services ...Middle East

Patients in rural areas face a potential “blackout” of pharmacies as thousands of owners threaten to restrict free deliveries of medicines and close at weekends.

Small business owners told The i Paper patients can expect “significant” disruption to services as a funding row with ministers continues.

Some patients are already driving up to 40 miles to get their treatment amid a medicines shortage and may need to travel further if hours start to be limited.

The last five-year government funding contract expired in March and officials have yet to offer a new settlement, leaving thousands of owners in the dark about their future.

Independent pharmacists have been taking out bank loans, remortgaging houses and dipping into their own pockets to make up a growing shortfall in funding which is forcing roughly eight pharmacies a week to shut, according to figures from the National Pharmacy Association (NPA).

The majority of pharmacies make money from delivering NHS services to local populations, including dispensing prescription and flu vaccinations, but can top up their income through retail sales and private services.

Mike Hewitson, who runs Beaminster Pharmacy, in Dorset, said: “Pharmacies will continue to fulfil their obligations to supply medicines to patients. If pharmacies withdraw delivery services then patients would have to arrange for someone to collect it, or in some cases might resort to taxis collecting medicines for them which would obviously incur a charge.

“Any withdrawal of hours risks patients having to travel further, go without their medicines, and access alternative sources of care. This potentially has a much greater impact in small towns where there may be no other pharmacies and in rural areas where there are bigger gaps between pharmacies.”

Some 99 per cent of pharmacies which voted in a NPA ballot last November said they would be prepared to cut their opening hours and services if a new agreement is not reached quickly.

The first services to be hit will be emergency contraception, addiction support and stop-smoking services. Evening and weekend opening hours are also likely to be cut.

While acknowledging the disruption to services, Mr Hewitson criticised the lack of involvement from the government or NHS in finding a resolution.

“Pharmacy contractors are more fed up than I have ever seen them. They are also becoming increasingly angry that there doesn’t appear to be any appreciation from government or from NHS England about the urgency of the problem”, he said.

“Every day pharmacies are striving to keep services running, often at great personal cost to the pharmacy owner and they are getting casual indifference from Government that has been saying talks are going to restart ‘soon’ for the last 6 months. There are real world impacts as a result of these delays.

“Similarly, reductions in out-of-hours services could indeed result in patients needing to travel further to access their medications, particularly in areas where pharmacies are already scarce. This is not something we want to see happen, but it is a direct consequence of a funding system that has failed to address rising costs and operational pressures for years.”

Mr Hewitson said the situation could be avoided if the government provides “immediate and meaningful support” to stabilise the sector.

“The solutions are within reach, but without urgent action, the impact on both pharmacies and the communities they serve will be significant,” he said.

Medicine shortages for many conditions, including cystic fibrosis and pancreatic cancer, are making a bad situation worse due to daily supply disruptions.

‘I had to borrow £125,000 to get through the year’

Ashley Cohen runs a pharmacy in Leeds

“The fact we are now into 2025 without the Government sitting down with our negotiating body leaves me incredulous. I look at my own financial situation along with other colleagues. I have had to go to the bank twice since January 2024 and had to borrow £125,000 to get us through this year.

“There are only so many times you can inject money from savings accounts, borrow from the bank or cash in on pension pots to keep your business afloat.

“The current government may not be to blame for the decade of underfunding, but they urgently need to step in now before it’s too late to give us the stability urgently required.”

Millions of people also face shortages of common migraine, diabetes and acne medicines.

Community Pharmacy England wants the Government to consider giving community pharmacists greater authority to make quantity, strength or formulation changes to some medicines without requiring prescriber approval.

Olivier Picard, who owns four Newdays Pharmacy shops in Berkshire, said: “Any form of collective action will inevitably have an impact on patients and communities. If pharmacies are forced to stop providing free services, such as delivering prescriptions or offering other support that remains unfunded, it will be patients who bear the burden.

“They may face out-of-pocket costs for delivery services or getting medications dispensed in MDS [Monitored Dosage System] packs for free, which are often essential for vulnerable or elderly individuals who cannot travel easily or with complex conditions.”

NPA analysis last year revealed that recent closures in towns and villages were threatening to turn some areas into “pharmacy deserts”. Of the 20 council areas with the lowest number of pharmacies per 100,000 people, 17 were in rural locations.

Mr Picard has said the current climate for pharmacies is the worst he has seen since he began his career in 2000 and urged ministers to finalise a funding settlement quickly.

He said: “Pharmacies are a vital part of the healthcare system, and the decisions we are considering are not taken lightly and always remain a last resort. However, the current situation has left pharmacies at breaking point, with no choice but to consider measures to ensure their survival and protect patient safety. Doing nothing is not an option in my opinion.”

‘Supplies are dangerously low – I spend hours chasing it ‘

Michael Harvey, 72, from Northallerton, North Yorkshire, was diagnosed with pancreatic cancer in 2017. Following successful treatment he was prescribed pancreatic enzyme replacement therapy (PERT).

There has been a shortage of PERT for more than a year, but it has intensified recently, with patients saying is the worst they have ever experienced, and pharmacists reportedly breaking down as they are forced to ration customer’s medicines.

Mr Harvey takes eight capsules of Creon – a form of PERT – before every meal and four before every snack. It means he requires 800 per month.

However, he said supply issues have been at their worst ever in the past 12 months, and he now hands in prescriptions with “hope rather than expectation”.

He has struggled to get his complete prescription fulfilled

The NPA, which represents around half of the 12,000 independent pharmacies across the UK, is calling for an annual £1.7bn funding increase to plug a “financial hole” facing the industry.

Core government pharmacy funding in England has fallen by 40 per cent since 2015-16, after adjusting for inflation. Around 700 pharmacies in England have closed over the last two years, the NPA said.

NPA chair Nick Kaye said: “Pharmacies have been pushed to breaking point due to the impact of 40 per cent cuts coupled with record pharmacy closures and increased demand for their services.

“Without urgent support from the government and a new funding settlement, many will have no choice but to cut their opening hours and limit value-adding care like free deliveries in a few weeks’ time in order to keep their doors open.

“Pharmacists are not a militant bunch and are very dedicated to supporting their communities but many feel they have no choice if they are to avoid closing and maintain access to vital medicines for patients.

“We feel we have a massive part to play in reducing pressure on the rest of the health system, but first we must see an urgent funding uplift and a halt to pharmacy closures.”

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A Department for Health and Care spokesperson said: “We inherited a pharmacy system that has been neglected for too long and isn’t supporting pharmacists to deliver the care they want for patients.

“Community pharmacy has a vital role to play as we shift the focus of the NHS out of hospitals and into the community, and we will shortly be resuming our consultation with Community Pharmacy England to agree new funding arrangements.”

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